1. The strength of ombudsmen in a disaster
HoUSton
Ombudsman Strong
The strength of ombudsmen in a disaster

2. Lessons Learned From Past Hurricanes
Rita - Evacuations are a mess for the 4th largest city, especially in August heat. 2.5 million tried to evacuate causing a 24 hour traffic gridlock and 100 deaths.
Ike – Storm surge areas should evacuate. Others shelter in place and have a generator. Contracts for bus services don’t always come through. Electricity took about a month for some areas to be re- established.
TS Allison, Memorial Day Flood, and Tax Day Flood – Flash flooding happens quickly and is unpredictable as new areas flood each time. Population boom of 35% since 2000.

3. What Happened in Harvey
51”
2 Reservoirs, Lake Conroe Dam,
and Brazos River Levee Neglect
Regulatory Disaster Operations in Austin. Local offices closed.
Hurricanes are predictable, but high and low pressure systems holding rain over an which areas and for how long are less predictable. Combining loss of prairie land with unprecedented rain fall, our rivers and bayous couldn’t contain the water. Long-neglected flood prevention reservoirs, damns and levees just added to the problem where contained water had to be released. Areas that had never flooded before were flooded.
Roads and highways all around were flooded, so facilities who needed to evacuate couldn’t get to the places in their emergency preparedness plan. Buses couldn’t get to some facilities and volunteer boat rescues were needed. Dry areas became islands.
Due to local regulatory offices being inaccessible, they were closed.

4. DURING THE EVENT, LOCAL OmbudsmEn Found out about more Evacuations than Regulatory
OMBUDSMAN STRENGTHS 1) Community. Ombudsman volunteers (especially) and staff tend to live in the communities of the facilities we visit. Evacuations are announced by neighborhoods and through local news. 2) Relationships with residents and families. Chances are we have the cell phone number of a resident or family member, and they have ours. 3) Regular visits. Even with high turnover of leadership staff at facilities, we tend to have the cell number of at least one person in leadership. 4) Role. We’re not regulators. Some facilities are more willing to talk with ombudsmen during times of crisis.

5. What We Did
During Storm Informed nursing homes and ALFs of waived 3-day hospital stay for Medicare coverage in SNF Communicated which facilities had available beds to other facilities and Regulatory Communicated which facilities were in evacuation areas and facilities we knew were evacuating and where
After Storm
Checked on evacuated residents
Learned when facilities planned to return
Checked facilities that took in evacuees for staffing sufficient to meet resident needs
Resident belongings – esp. DME equipment (CMS 1135 waiver to replace)
Helped residents and families find new placement (shortage of specialty Alzheimer’s care and affordable ALFs)
ALFs needing to evacuate to SNFs used the 3-day waiver for Medicare coverage

6. Questions For CMS fRom Harvey For Future Flooding Disasters
1) Case to Watch: Port Arthur police investigation and criminal charges against nursing home that refused for family and volunteer rescuers to evacuate 74 residents. 2) How much flooding is considered a danger to residents’ health? 1 inch, 1 foot, or 3 feet? How are health and safety concerns evaluated, such as contaminated water, mold, mucking, exposed electric wires, and construction noise. When is a new life safety inspection needed? 3) Do residents have the right to choose to evacuate even if the facility chooses not to when rescue crews arrive? How are medications and belongings handled in that situation? 4) When corporate offices make the choice not to evacuate, what recourse is there against corporations rather than individual facilities? 5) Do emergency preparedness plan requirements need to have more specific requirements due to risk of storm surge and location in flood plains? Should communication with local OEM be required? 6) How should Regulatory and the Health Care Facility Emergency Preparedness Coalitions access the strengths of ombudsmen? 7) Who pays for transportation when a resident wants to be moved to another facility closer to family?

7. Handouts Harvey Residents Lost Items
Senate Finance Committee Questions to CMS
m%20Chairman%20Hatch%20and%20Ranking%20Member%20Wyden.pdf (letter to CMS)
C%20from%20Senator%20Hatch%20and%20Senator%20Wyden.pdf (letter to TX HHSC)
A%20from%20Senator%20Hatch%20and%20Senator%20Wyden1.pdf (letter to FL AHCA)